Uninsured? Don't hold your breath for coverage

May 10, 2008|BY BOB LaMENDOLA STAFF WRITER

Don't expect miracles from Gov. Charlie Crist's new plan to cover the uninsured.

Insurance experts said the Cover Florida program passed by the Legislature last week will offer low-cost, bare-bones medical policies to the 3.8 million people without coverage, but the plans will not be out until next year and even then may be of limited value.

Few uninsured people have bought similar policies already on the market because the coverage is so minimal, insurance specialists said. And some critics say the program may lead employers to cut costs by substituting a stripped-down plan in place of better coverage they now offer.

"The plan, it makes great press," said John Erb, an employer benefits manager at Deloitte Consulting in South Florida. "It shows good intentions, but in the world of insurance, it doesn't offer much."

In a state where almost one-quarter of adults are uninsured, including 200,000 each in Broward and Palm Beach counties, the program aims to cover more by creating policies costing as little as $150 per month.

Exactly what would be covered is unknown. After the Legislature passed the bill (SB 2534) on May 2, state officials and insurers began designing policies to hit the market next year.

Some policies would cover major care such as hospitalization, but probably only to a maximum $10,000 or so per year. Some would cover only doctor visits, screenings and basics such as diabetic supplies. Prescription coverage is required but could be only a drug discount card. Insurers must take any enrollee, but may be able to exclude people with some pre-existing conditions.

To hold down premiums, the state will exempt insurers from covering most of 51 areas policies must now cover, such as cancer and mental illness. The idea is to let the uninsured and employers buy coverage they need but not what they never need, such as pregnancy care.

The system would create new options for eligible people uninsured for at least six months and not covered by public health programs, said Mark Thomas, chief of staff at the state Agency for Health Care Administration. The main target is healthy young adults who often go without coverage.

"For many people, this will be meaningful coverage. This will be robust," Thomas said.

Insurers and business leaders backed Crist. So did hospitals, trying to slow the tide of 1.65 million uninsured patients who came to emergency rooms last year, said Rich Rasmussen, a spokesman for the Florida Hospital Association.

"It's a step in the right direction," said Mel DiPietro, owner of Resource Benefits Inc. insurance brokerage in Plantation. He said people already are calling him about applying for plans.

But some experts question whether anyone would buy them. Several large insurers already offer similar bare-bones plans, Erb said, but "not very many people take them. They realize they are not a good deal."

The tax-supported Health Care District of Palm Beach County also offers a basics-only policy, Vita Health, for adults up to 55. It covers preventive care and a maximum 10 days in the hospital per year, and costs $150 per month, of which the district pays $100. In two years, about 1,000 people have signed up.

"It's growing, slowly," said Dwight Chenette, the district's chief executive. He said the district could not extend coverage to those over 55, who use more health care, because it was not possible to design a policy that offered even basic coverage and still made money for the insurer.

DiPietro said the state's program may be backward. Uninsured people typically prefer to pay for basic care out of pocket and buy high-deductible plans that cover major illnesses and hospitalization, he said.

Tamara Stella has no interest in Crist's program, even though the uninsured Delray Beach mother has had a lump in her breast for months and can't afford a mammogram.

"One hundred fifty dollars a month for a policy that doesn't cover anything? I wouldn't pay," said Stella, 42. "If you just want to see a doctor, you can go to a walk-in clinic and pay $95 when you are sick."

Some insurance specialists predicted the Crist program would appeal most to those denied coverage because they are sick. But those are not the ones insurers will want in the plan, said Don Staton, an agent in Boca Raton.

A second piece of the legislation, pushed by House Speaker Marco Rubio, R-Miami, creates the nonprofit Florida Health Choices corporation that would help small employers shop for bare-bones policies from private entities.

The entities would not be regulated by the state or have to meet minimum financial guidelines as insurers do. Oversight would be done but by the nonprofit group, run by a board of 15 political appointees using $1.5 million in state funds.

Supporters call the idea a free-market approach to match employers with new ideas from nontraditional sources. Critics, however, said the idea could open the door for unregulated firms to collect premiums with no guarantee they would provide coverage.

Bob LaMendola can be reached at blamendola@sun-sentinel.com or 954-356-4526 or 561-243-6600, ext. 4526.

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